Saturday, June 30, 2018

Philadelphia, PA., June 29, 2018 /Standard Newswire/ — Jahi McMath, an teenager at the center of an international debate on “brain death” criteria, died earlier this week due to liver failure.

“We fought for Jahi, her family, and her rights ever since her 2013 brain injury,” said Bobby Schindler, President of the Terri Schiavo Life & Hope Network. “After Jahi was ruled to be brain dead, she and her family found themselves in an incredible situation wherein Jahi was considered legally dead in California, but legally alive in New Jersey due to that state’s religious accomodations. Nailah Winkfield and Jahi’s entire family fought for nearly five years on the grounds that Jahi exhibited behavior inconsistent with the brain death diagnosis. Jahi was not only still alive, but may haves benefited from treatment and rehabilitative care.”

Brain death, known as the neurological criterion for death, was formulated in 1968 but has been the subject of vigorous debate since its inception. The Terri Schiavo Life & Hope Network advocates for revisions to the brain death criteria that allows for patients who may be experiencing severe coma or minimal consciousness to still have a chance at treatment and care.

“At present, to be ruled brain dead means that you’re considered dead,” continued Schindler. “Jahi lived for nearly five years after being declared dead thanks to the love and care of her mother. The way that Jahi, Nailah, and her family were treated by some physicians since 2013 has been a scandal—a case study in the human cost of elitist and bureaucratic disregard for a patient who needed care.”

That NBC, the Associated Press and others are reporting this week with headlines like “Jahi McMath, Oakland Teen at Center of Brain Death Debate, Dies,” ironically underscores the reality that so many have denied for nearly five years: Jahi was alive.”

“We will continue to advocate in Jahi’s memory for revisions to the ‘brain death’ criteria to ensure that patients who don’t meet the criteria in the future won’t be denied all care.”

The Terri Schiavo Life & Hope Network upholds human dignity through service to the medically vulnerable.

Komrad writes about what led him to become an expert on euthanasia for psychological suffering:

On Sept 8, 2017, I was invited to give the opening lecture in a fairly remarkable symposium in Belgium on their 15-year-old practice of the voluntarily euthanasia of psychiatric patients. I spoke to an audience of Belgian mental health professionals and administrators. My charge was to present to them something of “the outside world’s view” of this issue and to touch on the recently issued Position Statementby the American Psychiatric Association (APA) regarding medical euthanasia: “. . . a psychiatrist should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death.”

Komrad then establishes the current situation concerning psychiatric euthanasia in Belgium:

In 2002 Belgium legalized euthanasia by physician (typically by injection) at the request of patients, and removed any distinctions between terminal vs. nonterminal illness, and physical vs. psychological suffering. As long as the condition is deemed “untreatable” and “insufferable,” a psychiatric patient can be potentially eligible for euthanasia. There is a consultative process that basically needs a minimum of two doctors to agree about the patient’s eligibility. Also, the patient gets to weigh-in on whether their condition is “treatable.” Since the patient has the option to refuse treatments, this refusal may create an “untreatable” situation.

The evaluation pathway even makes it possible for a psychiatric patient to be euthanized with only a single psychiatrist in support. Once approved, some patients are euthanized by their own treating psychiatrist. Alternatively, there are other physicians who will perform euthanasia; though the number of such euthanizers is small (in fact, a large proportion of psychiatric euthanasia's are performed by one particularly zealous Belgian psychiatrist, Dr Lieve Thienpont).

It was made clear to me on my arrival that the majority of Belgians and their mass media support this practice. I learned that although a number of psychiatrists feel very negatively about this, they are reluctant to speak out for fear of being vilified in the press. Though back in 2002 several individual psychiatrists lobbied against the proposed law, medical organizations did not, and have not expressed objections. Organized medicine has not articulated a stance on this because there isn’t a strong enough consensus among doctors, not even psychiatrists, I was told. Also, I learned there isn’t a strong tradition of ethics activities at the organizational level, or significant focus on an ethics code. The Belgian professionals were quite aware that the majority of the world ’s medical associations disagree with the medical euthanasia in general. It seemed almost a point of honor that they differed in this way, as if they are on higher moral ground in a bold new era of medical ethics.

Komrad then writes about his presentation he gave in Belium on psychiatric euthanasia:

My presentation was titled “Voluntary Euthanasia of Patients with Mental Illnesses: An Inversion of Psychiatry’s Fundamental Clinical and Ethical Values.” I reviewed a great deal of data about psychiatric euthanasias in The Netherlands and Belgium, demonstrating how there has been a profound “mission creep” in both countries, with an ever-widening diameter of eligibility, leading to an appalling slippery slope. I did make mention of the ways that the leading and most celebrated psychiatrists in Nazi Germany lost their ethical moorings, swept along by a powerful social movement, and participated with dedication and relish in the “T4” program to exterminate the mentally ill.

The lesson is how physicians are vulnerable to a social tsunami, which can detach us from core medical ethics with enthusiasm, convinced we are pioneering a virtuous new moral frontier. I reviewed the positions of several international medical and psychiatric bodies that are against some of these practices, including that of the APA. I then addressed a variety of social, clinical, financial, and ethical concerns about psychiatric euthanasia. I particularly emphasized what I called the “fundamental ethos of psychiatry” to prevent suicide and its special skill set to address hopelessness, helplessness, desire to die, and inability to see a better future. Human suffering is our core focus, and we have a skill set to accompany a patient in their suffering, no matter what the diagnosis. Our approach is to address that suffering in various ways, but not by snuffing out the life of the sufferer. We prevent suicide, not provide it.

Komrad then commented on the justification that was made for psychiatric euthanasia:

I went with an open mind to try and grasp the arguments in support of psychiatric euthanasia from the people and clinicians immersed in it as a “treatment” option. What I heard from several other speakers (philosopher, psychiatrist, psychologist, Jesuit priest who was also a physician) was actually very disturbing to me. I was powerfully struck that these professionals, who had been living with this as the law of the land, a fait accompli, were starting with the accepted conclusion that it was OK, and reasoning backwards to create an a postiori justification. The conclusions are a given, so arguments were sought specifically to justify the conclusion, and ideas that would lead to a contradictory conclusion were filtered out. It was a powerful kind of sophistry. Indeed, there was even an apologetic tone by some speakers; they seemed to be apologizing to themselves as many were uncomfortable with the conclusion.

The speaker who represented the new ethical stance of The (Christian) Brothers seemed to convey in his apologetic tone—“we really don’t want to do this, but the society we live in wants it.” They were justifying literally killing (on request) the very kinds of patients to whose hopelessness and helplessness psychiatrists are devoted to address. My reaction was visceral; I found myself eyeing the exits to bolt out and get some fresh air. It wasn’t hard to imagine that I was at a psychiatric conference in pre-war Germany, listening to learned speakers intellectualize uses of psychiatry that were trying to topple the millennia-old gyroscope of medical ethics in service of radical progressive shifts in social mores.

Euphemisms abounded that permitted a disengagement from the prior, traditional moral baseline. There was talk of “compassion,” “listening to and respecting the patient’s wishes,” “the end of doctor-knows best,” and an apotheosis of autonomy to the point where it actually seemed fetishized. It was certainly easy to follow the arguments for compassion, not abandoning the patient, taking the patient’s suicidal wishes seriously, exploring the extensive underlying reasons for wanting to die, etc. All of these penultimate approaches sounded like good, solid psychiatry.

Komrad states that Belgium has developed two new areas of psychiatry, that may have positive outcomes. The Belgium Recovery Model uses peer support among psychiatric patients approved for euthanasia. They have also developed "palliative psychiatry" which is a form of intensive psychiatric treatment for psychiatric patients who have requested euthanasia.

I am not an expert but I would suggest that the Belgium Recovery Model may have the opposite effect, meaning, peer support among psychiatric patients approved for euthanasia may in fact create a greater desire to die by lethal injection.

Komrad completed his article by expressing little to no hope for change in the Benelux countries:

I don’t want to say that nobody had problems with it. There were some calls for modification of the law, extending the wait between approval and administration of euthanasia for psychiatric patients to at least a year. The sense was the system needed some “fine tuning” but was fundamentally acceptable. Outrageous cases are “exceptions to an otherwise good system.” There was, however, a small group of professionals who saw the whole situation as very negative, dire, and deeply disturbing. On two different nights they invited me to dinner to ventilate their concerns in a more private setting.

What was not presented at all was justification for taking the very last step— killing the patient, for the physician him or herself to engage in killing. I had hoped at the very least to hear the Belgian health care establishment support euthanasia, but protest that it should not be occurring in the House of Medicine, by the hand of a physician, and unhappiness that society had come to expect that of them. It was quite clear to me that these professionals who spoke have been living with this for far too long. They are too far down the rabbit hole at this point. Those who became mental health professionals 15 years ago were professionally born into this paradigm, and it’s all they have known their entire careers. The youngest physicians have grown up in this paradigm since childhood.

Sadly, I left without much hope for Belgium to reverse its stance on psychiatric euthanasia. It has been too many years, there is too much widespread buy-in, the professional societies cannot get sufficient coherence to express a viewpoint or take a stand, and psychiatrists fear being seen as cruel, or retrogressive, or “crypto-Catholic” if they speak out too loudly as individuals. The press will flock to their door with unpleasantly critical, challenging interviews. As of the publication of this article, The Belgian Brothers of Charity remain open to performing euthanasia in their facilities.The influences of the APA and WPA as prominent voices of organized psychiatry are important. But, unless the medical and psychiatric establishment in Belgium can get its act together and speak coherently against this appalling practice, objecting psychiatrists will have to continue to whisper their worries to each other, and little Belgium will likely continue to convince themselves that they are virtuously righteous in letting their doctors provide suicide to certain non-terminal suicidal patients who are “untreatable” and request death.

I am not so negative about the prospects for Belgium. Similar to any social change, once people come to understand the horrific outcome of permitting euthanasia, overtime they will also come to reject the killing. If not, someday, they will uncover the deception of euthanasia and decide that the killing must stop.

The Baby Alfie Evans’s case this year shocked the world but now we learn his forced death against his parents’ wishes follows a legal and healthcare nightmare in the UK.

Some of us expressed concerns years ago about the UK’s “Liverpool Care Pathway” developed in the 1990s to improve care of the dying by applying “the high standard of palliative care prevalent in hospices to other clinical settings”. But the “Liverpool Care Pathway” went horribly wrong and in 2009, the UK Daily Mail published an article “Euthanasia by the back door: Hospitals ‘death pathway’ is open to error” with cases of non-dying patients considered “not worth saving” who died from the “combination of dehydration and powerful painkillers”, explaining that:

“Under the Liverpool Care Pathway, doctors can withdraw fluids and drugs from patients if they are deemed close to death. Many are then put on continuous sedation so they die free of pain.

But sedation can often mask signs of improvement, meaning doctors may be closing the door on people who would otherwise live for months.”

“(a)vacuum left by the abolition of the LCP makes a return to the ‘bad old days’ of poor or non-existent communication about dying a real possibility: we would argue that the response to poor use should be right use, not non-use” and called for “increased funding and training in palliative care and suggest that skills in end-of-life care should become a required competency for all health care professionals.” (Emphasis added)

The Gosport Hospital (UK) Independent Panel Report

More details of this scandal have just now surfaced in a report on the Gosport War Memorial Hospital where patients were often admitted for rehabilitation or respite care. The report concludes that at least 450 patients had their lives “shortened” by denial of food and water along with powerful painkillers between 1989 and 2000. It details cases and concerns and ultimately acknowledges the families’ years-long pleas for the truth. Here is one excerpt:

“Those (nurses) who raise concerns about the conduct and practice of colleagues are now widely known as ‘whistle-blowers’. To put it into context, it is generally agreed that the NHS (National Health Service) has not been good at protecting people who take such a difficult step; as the documents make clear, the events of 1991 were no exception. Nor should the consequences for whistle-blowers be underestimated: these commonly included disciplinary action and undermining of professional credibility.”

“The documents show that, following a complaint to the Trust in 1998 and the police investigation, it should have become clear to local NHS organisations that there was a serious problem with services at the hospital. Although the successive police investigations undoubtedly complicated the NHS response, it is nevertheless remarkable that at no stage was there a public admission of failure or any public apology. Nor was there a proportionate clinical investigation into what had happened. On the contrary, the documents show numerous instances of defensiveness and denial – to families, to the public and the media, and to health service and other organisations.” (Emphasis added)

Conclusion

Will charges now be brought against those involved in the Gosport War Memorial Hospital euthanasia deaths? Who knows? The Independent Panel only concluded that:

“With this Report and an online archive of documentation, the Panel has completed its Terms of Reference. The Panel now calls upon the Secretary of State for Health and Social Care and the relevant investigative authorities to recognise the significance of what is revealed by the documentation in this Report and to act accordingly.”

Yuill correctly points out that if assisted suicide or euthanasia were legal that, similar to Gosport, killing would become more mainstream and simply accepted. Yuill writes:

Writing in The Times, Dominic Lawson says there is something obscene about the ‘shortening’ of the lives of more than 450 patients who were staying in Gosport War Memorial Hospital. He is right.

The Gosport scandal concerns the ‘shortening’ of 456 patients’ lives through the excessive use of painkillers at the hospital in Hampshire between 1989 and 2000. An inquiry, the Gosport Independent Panel, says such ‘life-shortening’ had become virtually routine.

The use of the word shortening is striking. We might say that Jack the Ripper ‘shortened the lives’ of prostitutes in the East End of London. In fact, if we employ the rather ludicrous measurement of time left – QALYs, or quality-of-life years, as some experts say when referring to care for the elderly in particular – then the doctors who presided over the regime of ‘shortening’ lives in Gosport undoubtedly stole more time than the Ripper could ever have managed.

Even the term ‘patients’ in this discussion masks the real people involved, with their experiences, lives, loves, families, and, yes, hopes. The report into the scandal anonymised mothers, fathers, grandmothers, brave veterans, beloved teachers, aunts and uncles, friends and rivals, reporting as if they were victims of some foreign disaster rather than having been purposefully killed.

Yuill then explains that sometimes heavy sedation is required to prevent suffering:

There are, admittedly, some situations – now thankfully rare – when a doctor must heavily sedate patients to prevent suffering in the last hours of life. But Gosport wasn’t like this. It appears that the killings took place because the people involved were ‘inconvenient’. This was revealed in a meeting between members of staff about an annoying patient, where the following alarming exchange took place: ‘We agreed that if he wasn’t careful he would “talk himself on to a syringe driver”.’ According to the report, that patient, who was able to walk, talk and dress himself, did have a syringe driver and died the next day. Many others were also seemingly despatched for being irritating. Fifty-five per cent of those who were given lethal doses of diamorphine were not in pain. In 29 per cent of cases, the notes give no justification at all for the lethal dose.

Yuill then challenges the assisted suicide lobby and their cultural engineering:

Much more than an event like the Grenfell disaster, the treatment of these individuals indicates how far a moral crisis besets this country. As expressed all too clearly in our language, human lives are no longer sacred. Another euphemism beloved by people like Polly Toynbee, who summoned her mother from the grave yet again to argue for legalised assisted suicide, is ‘choice’. Everyone wants to have choice. ‘Compassion and Choices’ is the new, improved name for the Euthanasia Society of America. British lobbyists Dignity in Dying (formerly the Voluntary Euthanasia Society) want to ‘allow a dying person the choice to control their death’.

Let’s leave aside the fetishising of the moment of death when people seem to want their favourite music playing (hint: you won’t hear the end of the song). It is actually this misuse of the concept of ‘choice’ that led to the monstrous events in Gosport. The ‘choice’ referred to by pro-assisted dying organisations is actually suicide. But by calling it a choice, we remove all moral responsibility from the action. The culture of assisted dying reduces the most profound decision a human can make – whether to shuffle off this mortal coil – to a medicalised menu selection. The decision to execute a human being in the United States – even a horrific rapist/murderer – is at least attended with ritual and ceremony, as if something of huge moral importance is occurring. With assisted dying, suicide is given as a treatment option in a pamphlet. The message is ‘we won’t judge’ – that is, ‘we don’t care if you live or die’.

If such an ‘option’ is offered so casually to individuals, why would it be surprising that a doctor should treat human lives just as casually? If the act of suicide carries no real moral responsibility for the individual, why would killing a patient – or ‘shortening a life’ – carry any special moral responsibility for a doctor? We make it easy to wink and, as the Gosport report notes, tell the nurses to ‘Make the patient comfortable. I am happy for nursing staff to confirm death.’

Elderly people already find themselves resented for inconveniently continuing to exist, for voting for Brexit, for blocking beds, for taking up the time of harried NHS staff. Assisted suicide is always preferred for those who have little time left. In the country that has tolerated assisted death the longest – the Netherlands – plans are afoot to extend assisted death to all those over 70 who are ‘tired of life’. How many lonely elderly Dutch people will be despatched in a similar fashion to the patients at Gosport?

Hopefully someone will be found responsible for the crimes that took place in Gosport. But it is really an entire culture that supports assisted dying, that believes that life and death are nothing but menu selections, that must be changed if we are to avoid future scandals like this one.

The experience with every jurisdiction that permits euthanasia or assisted suicide is that once it is legalized it expands in the number and situations whereby death by lethal drugs is considered a response to difficult human conditions.In Canada, The Third Interim Report on Medical Assistance in Dying (euthanasia and assisted suicide) was recently released by health Canada indicating that the number of deaths by lethal drugs has increased by 30% in the second half of 2017 (July 1 - Dec 31, 2017)The data indicates that there were 1525 reported assisted deaths in the last 6 months of 2017. There were 1179 reported assisted deaths in The Second Interim report for the first 6 months of 2017. There were 3714 reported assisted deaths since parliament legalized euthanasia and assisted suicide, up to December 31, 2017.

37% of forms/reports from doctors, and an unnamed percentage of reports from institutions, needed more information. Some doctors openly refused to provide the additional information requested by the Commission.

A 5% or 7% error rate (with 3% undetermined) would not be acceptable where lives depended on the effective application of safeguards (e.g. the airline industry).

The three cases in which the safeguards were clearly violated (two where the person did not have a “serious and incurable illness” and one where the person was not at the “end of life”) were not addressed as the crimes that they are.

To make matters worse, in June 2017 an Ontario judge extended euthanasia to people who are not terminal ill. The judge redefined the phrase "natural death must be reasonably forseeable" to permit doctors to kill people who are not terminally ill.There may be unreported assisted deaths.The Canadian government established a similar self-reporting system, as exists in the Netherlands and Belgium. This means that the doctor who carries out the death is the same doctor who reports the death (no independent oversight of the law) therefore if under-reporting or abuse of the law occurs, no one will know. Based on the first Québec government's first euthanasia report 14% of the assisted deaths did not comply with the law.The number of Canadian euthanasia deaths is high when compared to Belgium where there were 235 reported assisted deaths in the first year (2003) of legal euthanasia and 349 in the second year and 393 in its third year after legalization. In 2015, there were 2021 reported Belgian assisted deaths. Belgium has approximately 1/3 of Canada's population.

Wednesday, June 27, 2018

Press Release issued on behalf of Care Not Killing (UK)RELEASE DATE: Wednesday 27th June 2018Care Not Killing (UK) welcomes the Court of Appeal’s sensible decision to reject this latest attempt to legalise assisted suicide and to uphold fully the earlier decision of the divisional court.

The case, brought by Noel Conway, argued that the current blanket ban on assisted suicide under the Suicide Act is incompatible with his human rights.

However, this argument has been repeatedly rejected by the Courts, only last year in the Divisional Court three senior and experienced judges dismissed this argument, saying:

“It is legitimate in this area for the legislature to seek to lay down clear and defensible standards in order to provide guidance for society, to avoid distressing and difficult disputes at the end of life and to avoid creating a slippery slope leading to incremental expansion over time of the categories of people to whom similar assistance for suicide might have to [be] provided... we find that section 2 (right to life) is compatible with the Article 8 rights (private and family life) of Mr Conway. We dismiss his application for a declaration of incompatibility.”

The Court of Appeal has now fully upheld this earlier judgement and ruled that the current blanket ban on assisted suicide achieves a fair balance between the interests of the wider community and the interests of people in the position of Mr Conway.

The objectives of this ban are not limited to the protection of the weak and vulnerable, but also include respect for the sanctity of life and the promotion of trust between patient and doctor in the care relationship.

In British Parliaments there have been over ten attempts to change the law on assisted suicide since 2003, all of which have failed. The most recent of these, was in the House of Commons in 2015 and was defeated by the huge majority of 330 to 118.

Members of Parliament, just like every major doctors’ group and disability rights groups expressed concerns about public safety, the failure of safeguards in the handful of places that have assisted suicide or euthanasia and the discriminatory message removing universal protections, from the sick, elderly and dying would send.

Dr Peter Saunders

Dr Peter Saunders, Campaign Director of Care Not Killing commented:

“This sensible decision by the Court of Appeal yet again recognises that the safest law is the one we already have - a complete ban on assisted suicide and euthanasia. Our laws deter the exploitation, abuse and coercion of vulnerable people, who as we have seen in the US States of Oregon and Washington often cite feeling they have become a financial, or care burden as the reason for ending their lives.

“While there are those who argue that feeling that you are a burden on others is reason enough to seek help to kill yourself, it is this sort of chilling and regressive view that led Paralympian Baroness Grey-Thompson to warn that vulnerable and disabled people risked being collateral damage, if the law were to be changed. This view is echoed by the British Medical Association, the Association of Palliative Medicine, the Royal Colleges and Care Not Killing.

“We hope that those who have been campaigning to remove these important and universal protections from the disabled and infirm accept this ruling. It is now time for them to move on and turn their attention instead to how we can secure equality of access to the very best health care for all. This must include palliative care and mental health support, because we know when the physical, psychological and spiritual needs of patients are met, there is no pressure for change.”

Tuesday, June 26, 2018

In the course of challenging California’s End of Life Option Act, we have learned that a handful of doctors have written most of the prescriptions for lethal drugs since the law went into effect.

Life Legal attorneys have uncovered shocking facts about how California’s assisted suicide law is being implemented and who is doing the “assisting.”

One of those doctors is Lonny Shavelson, a former contract ER doctor who came out of retirement as soon as the law was passed to dispense lethal prescriptions. Shavelson is not board-certified in any medical specialty, including diagnosing or treating mental illness, which is often at the root of a request for suicide.

His sole “practice” consists of getting people to die.

Shavelson admits to having “attended at bedside” as 89 people committed suicide. He stresses that the lethal drugs must be taken within 2 minutes, or they can “fail.” By “fail,” he means the people don’t die—and may decide that they don’t want to kill themselves.

In his book “Chosen Death,” Shavelson writes about observing an assisted suicide. Gene, a lonely widower, contacted the Hemlock Society, which has since changed its name to “Compassion and Choices.” “Sarah” the head of the local Hemlock Society office, came to Gene’s home to prepare and dispense the deadly concotion. This was not Sarah’s first experience with “assisting” a person’s death. She called it “the most intimate experience you can share with a person. . . . More than sex. More than birth . . . more than anything.”

Sarah held Gene’s head on her lap as she gave him the suicide drugs. As he started to fall asleep, Sarah put a plastic bag over his head and told Gene to “Go to the light.”

But the drugs failed. Gene woke up and started screaming.

Shavelson describes what happened next:

“His good hand flew up to tear off the plastic bag. Sarah’s hand caught Gene’s wrist and held it. His body thrust upwards. She pulled his arm away and lay across Gene’s shoulders. Sarah rocked back and forth, pinning him down, her fingers twisting the bag to seal it tight at his neck as she repeated, ‘the light, Gene, go toward the light.’ Gene’s body pushed against Sarah’s. Then he stopped moving.”

As Wesley Smith writes, “There is a word that describes what happened to Gene, and that word is murder.”

There is no evidence that Shavelson ever reported the circumstances of Gene’s death to authorities.

Why would he?

Once a person requests assisted suicide, the law presumes that everyone—the doctor, the suicide facilitator, family members, hospital workers—is acting with the purest of intentions.

Here is how the law protects bad actors:

Unlike other suicides, law enforcement will not investigate an assisted suicide to determine the cause of death or whether the person was coerced or forced—or if the person was murdered after he changed his mind, as Gene was.

The underlying disease —not suicide—is listed as the cause of death, which means doctors and coroners have to lie on the person’s death certificate.

In fact, the law does not permit the use of the word suicide to describe the process of self-ingesting a lethal dose of barbiturates to end one’s life.

If a doctor was negligent in making the initial diagnosis or prognosis, no one will know because all records will state that the person died of the alleged disease.

An “interested” witness—someone who will benefit financially from the person’s death—can sign off on the suicide drug request.

A family member can initiate the request for assisted suicide—Shavelson says that most of the calls to his suicide clinic come from family members, not from the person seeking suicide.

Any doctor or osteopath can write the prescription. No prior doctor-patient relationship with the person seeking suicide drugs is required.

No mental health evaluation is required, even though the majority of people who receive a terminal diagnosis suffer from depression.

Someone else can pick up the lethal drugs from the pharmacy.

In short, assisted suicide laws are designed to facilitate the perfect crime.

So how does this affect me?

You might wonder how this affects you or your loved ones since you would never seek assisted suicide.

Proponents of assisted suicide want to normalize suicide as THE end-of-life option. It is not an accident that California’s law is called the End of Life Option—not options—Act.

Shavelson’s goal is for hospice to “take over” assisted suicide. Compassion and Choices—the former Hemlock Society now heavily funded by George Soros—wants to “change the health care system” so that suicide is legalized nationwide. Faye Girsh, Senior Adviser at the Final Exit Network, says it should “be a crime” to not allow someone to kill themselves. Dr. Philip Nitschke, Director and Founder of Exit International, says “people have a right to dispose of [their] life whenever they want.”

Former Compassion and Choices litigator and head of the End of Life Liberty Project Kathryn Tucker says “it would be appropriate for the practice to become more normalized within the practice of medicine, with less government oversight and regulation.”

Life Legal regularly handles cases involving the denial or withdrawal of life-sustaining medical care without the patient’s consent. People are starved and dehydrated to death against their will because it has become “normalized within the practice of medicine” to deprive people of basic care.

I shudder to imagine what full-scale normalization of assisted suicide would look like.

Saturday, June 23, 2018

Peter Stockland, the former editor-in-chief of the Montreal Gazette and the publisher of Convivium forum was published in MacLean's Magazine on June 22, 2018 stating that MAiD (euthanasia) was supposed to be an option, but is becoming, in some cases, the only option.

Peter Stockland

By Peter StocklandCanadians were asked in 2016 to accept what is now called Medical Assistance in Dying (MAiD) as standard practice in the health-care system. But as the second anniversary of the federal law sanctioning assisted suicide passes this month, ambiguities embedded in the new regulatory regime are turning end-of-life care into a troubling leap of faith for doctors and patients alike.

Even the Collège des Médicins in Quebec, which sped ahead with its own statute in advance of Ottawa’s Bill C-14, has sounded a strong warning note about patients “choosing” medical assistance in dying purely because their preference for palliative care isn’t available.

“End-of-life care cannot be limited simply to medical assistance in dying,” Collége President Dr. Charles Bernard writes in a May 29 recently published letter to provincial Health Minister Gaétan Barrette. “That option makes no sense, from a medical point of view, unless it is part of a robust and complete system of palliative care in Quebec.”

Yet provincial foot-dragging on plans to substantially expand palliative care services is actually denying patients the very choice that was promised in the shift to MAiD, and making it increasingly problematic to discern which patients truly wanted to have a doctor deliberately end their life, Bernard says.

“In certain identified cases, patients, for the lack of (palliative) care, might have had no choice but to ask for medical assistance in dying to end their days ‘in dignity,’ which deeply concerns us,” the Collège president tells the minister.

Worse, he adds, the Collège has been hearing increasing concerns from its member doctors about re-direction of already scarce resources from palliative care to medical assistance in dying, which risks a violation of both the letter and the spirit of Quebec’s law governing end-of-life care.

At the other end of the country in British Columbia, an active proponent of MAiD, acknowledges that she, too, struggled to adapt to the vagueness of the federal law. Dr. Ellen Wiebe says she ultimately concluded she would have to rely on her personal best judgment about whether or not to administer death. Neither the re-written federal legislation, nor provincial regulations that followed it, define with clarity when a patient can receive MAiD, she says.

At the same time, Wiebe believes wholeheartedly that any mentally competent person who requests medically assisted death for the relief of suffering has a right to receive it. And suffering, she says, is a subjective judgement for the patient to make. The result, she says, frequently leaves her working “at the edge” of the law.

A prominent voice in the Dying With Dignity movement, Wiebe says when she undertook training in the Netherlands for administering euthanasia, she saw the issue as one of a clear-cut human right to autonomy. Falling back on personal judgment felt paternalistic to her. Leaving it to the personal judgment of some professional authority—even a doctor like herself—felt like interference in a fundamental human right to die when one chose.

“Then when I started doing it, I realized that I personally must be convinced in each case. I provide what is right up to the edge of the law, and never beyond, of course. I’m working beyond where some providers would work…it varies on how risk-averse people are. We have to submit 17 pages of paperwork, and we are being scrutinized line by line.”

She acknowledges, however, that the line, or edge, has already shifted significantly since she provided her first medically-assisted death in February 2016. (That was four months ahead of the law being changed to make it legal, but Wiebe notes she had judges’ approval to proceed.) Part of the challenge is the federal legislation now permits—or limits, depending on perspective—MAiD to when death is in the “foreseeable future” but does not clearly define what that means.

Wiebe says the personal definition she initially worked from was based on testimony federal Justice Minister Jody Wilson-Raybould gave to the Senate on June 1, 2016. Kay Carter, the central figure in the 2015 Supreme Court decision that led to the overturning of the old law, would qualify under the “foreseeable future” wording, according to the justice minister.

In her testimony—two weeks before Bill C-14 became law—the minister said the legislation was “carefully crafted” to give “purposeful flexibility” to doctors. It did not set time limits or require proof of a “causal relationship between any single medical condition and the foreseeability of death.”

Wiebe notes that Kay Carter was 89 when she died, and had suffered from spinal stenosis, a painful though non-life threatening, condition. Her life expectancy would normally have been about five years, she says, adding: “If that was natural death in the foreseeable future according to our justice minister, then that was good for me.”

But just over a year later, in June 2017, Ontario Superior Court Justice Paul Perell ruled in a case called A.B. versus Canada that a 77-year-old who suffered from inflammatory arthritis faced death in the “foreseeable future” and was eligible for MAiD even though, as Wiebe points out, the woman’s life expectancy was about 10 years and she was still an avid hiker.

Wiebe says she adjusted her personal judgement accordingly, though she remains “very, very careful” in such cases where pain relief is the primary objective and non-terminal conditions are involved. She is confident the oversight system of the B.C. coroner’s office and the province’s College of Physicians and Surgeons acts as an effective public safeguard. “I expect,” she says, “to be scrutinized.”

But B.C. Conservative MP Mark Warawa wonders where that scrutiny and those safeguards were last January when Wiebe entered a Vancouver Orthodox Jewish nursing home and administered medical aid in dying to an elderly patient even though the facility didn’t allow MAiD and Wiebe didn’t have visiting privileges there. Administrators at the Louis Brier Home accused her of “sneaking in and killing” the patient.

Wiebe emphatically rejects suggestions of wrongdoing. On the contrary, she says, she works within the law to protect the rights of patients to receive MAiD whether or not the facility permits the procedure.

“To me, places don’t have moral rights. Places don’t have consciences, only people do. It’s not just any place. It’s [the patient’s] home. Someone [denying MAiD] is taking [a patient’s] rights away to die in their home. That’s why a place should never have rights.”

Warawa says the fact there wasn’t a criminal investigation is troubling enough. The current law allowing MAiD is due to be reviewed by 2021. How can any such review of Bill C-14 be meaningful, he asks, when existing legislation apparently isn’t being enforced in cases such as Wiebe’s?

“In my opinion, Ellen Wiebe broke the law, and the police should have been involved,” says Warawa, who sat on the special legislative committee that held hearings into C-14 before its passage. “I respect that people now have the right under the law to end their life prematurely through assisted suicide. But as a legislator, I think it would be a horrendous mistake to even consider expanding it when we aren’t upholding what already exists.”

Echoing the concerns now being voiced by doctors in Quebec, Sarnia-Lambton MP Marilyn Gladu is most concerned about the detrimental effects on palliative care that might come from the rising clouds of confusion around MAiD. Gladu achieved the remarkable feat in late 2017 of having her private members bill adopted unanimously by both the House of Commons and the Senate. The bill binds the Liberal government to having in place a framework for palliative care by December of this year.

But it took six months for the health minister to open a promised nation-wide consultation to get consistent palliative access. And Gladu still doesn’t know if the minister has made good on a commitment to consult with her provincial colleagues. She also points out that the word “palliative” was mysteriously absent from the recent federal budget, though Health Canada says that since 2017 federal government has committed to giving the provinces $6 billion over 10 years from a combination of homecare and palliative care, along with another $184.6 million for home care and palliative care in Indigenous communities.

All that would be disconcerting enough for Gladu. It’s made worse at the provincial level B.C.’s NDP government has mandated that MAiD be made available in all hospices and palliative care centres that receive 50 per cent or more of their funding from tax dollars.

“That is a really bad idea,” Gladu says. “People doing palliative care don’t have the same experience as people doing medical aid in dying. They’re not as familiar with the requirements.” A new standard recently issued by the Nova Scotia College of Physicians and Surgeons would allow paraplegic patients to receive MAiD if they’ve refused the treatment and medicine necessary to prevent bedsores.

“Clearly, that is not the intent of the legislation,” Gladu says.

Gladu adds that a highly probable unintended consequence will be to frighten patients away from palliative care and leave them, as Quebec’s Collège des Médicins is now warning, believing the “choice” of medical aid in dying is the only real option they have if they wish to die with dignity.

That would be a troubling example indeed of good faith requiring blind faith to ignore a looming hard fall for Canada’s public health care system.

Peter Stockland, a former editor-in-chief of the Montreal Gazette, is publisher of Convivium, an online forum for faith-based debate on public policy and social issues.

“Fatal Flaws” features filmmaker Kevin Dunn who spent three years traveling throughout Europe and North American asking the question “should we be giving doctors the right in law to end the life of others by euthanasia or assisted suicide?”

In the film, Mr. Dunn respectfully interviews people and experts on both sides of the issues and the candid testimonies are powerful and moving. I have viewed the film myself and I believe that showings of this film to senior citizen groups, pro-life groups, churches and clergy, medical professionals, etc. would go a long way in educating the public, many of whom are supportive or unsure of where they stand.